Samantha: A Story in Pictures

Samantha is a beautiful child with unusually long eyelashes and light brown skin who loves to draw. Samantha also has HIV, which she acquired from her mother at birth. She barely remembers her mother, who died of complications from HIV when Samantha was three years old, and she never knew her father, who returned to Puerto Rico soon after she was born. She made these drawings when she was nearly eight years old. Her foster parents were then near the end of a process that would culminate in her adoption—an event that she was eagerly awaiting. The drawings reflect the confluence of several themes in her life: her awareness of adoption proceedings, her ambivalent attitudes toward death, and the emotional turmoil she still carries with her from those early days with her family.

Helen, Samantha's foster mother, gave me a copy of these drawings during a routine clinic visit. I had been attending our hospital's pediatric HIV clinic for some three years, gathering material for what eventually became a book. ¹ As we sat in the examination room waiting for the doctor, Helen showed me each page and gave me her version of Samantha's explanation. Samantha was there by her side, nodding shyly at times as Helen spoke. The legend on each page represents this explanation, which I wrote down during Samantha's medical examination, checking it with Helen afterward. The following story of this child's life was told to me by Helen. Helen has seen and approved my narrative of her story about Samantha and has given me permission to publish both the drawings and the accompanying narrative. All the names and identifying details have been changed to protect the privacy of the individuals described.

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Samantha was three years old when her mother died. She was taken in by an aunt, but after six months the aunt was jailed for drug abuse. Samantha then went to live with a cousin, who was also infected with the virus. Helen claimed that the cousin did not send her to school, refused HIV treatment for the child, and rejected suggestions about foster care placement. After two or three years, Children and Youth Services intervened; Samantha, then six and a half, was forcibly removed from her cousin's by the police and placed in the home of Helen and Carl Parker. Helen called our pediatric HIV clinic immediately to make an appointment for Samantha. They were scheduled to come in later that same week.

I met the child and her foster mother during Samantha's first visit to our clinic, in April 1997. Back then she was a sickly child with deep black circles under her eyes and sores in her mouth and around her nose. Helen told us that Samantha complained continually of "feeling bad." There were difficulties with this first medical visit. Samantha was uncooperative with the nurses, balking at being weighed and measured and having her blood pressure taken. She was terrified of the physician who tried to examine her, screaming when he attempted to palpate her spleen and cervical lymph nodes. When the staff showed some concern over this, Helen suggested that Samantha may have been abused, indicating that Samantha was still "keeping her distance" from her new foster father. Lab work revealed that she had a high viral load, whereupon she began treatment with combination therapy.

Over the next few months, Samantha changed dramatically—in every way. As her viral load was reduced to an undetectable level, her overall health improved remarkably. When she and her foster mother came to the clinic for monthly appointments, the affection between them was evident. Indeed, they have always seemed to me an exceptionally good match. Helen is a voluble, outgoing woman who is generous and very demonstrative. And Samantha, who still remains somewhat aloof and emotionally cautious, clearly responds to and returns her foster mother's affection. Helen is the primary caregiver in the family since her husband, Carl...